Efficacy and safety of vancomycin for local application in the prevention of surgical site infection after joint arthroplasty: a systematic review and meta-analysis.

Purpose: The aim of this systematic review and meta-analysis is to explore the effect of topical vancomycin powder (VP) in surgical site infection (SSI) prevention and adverse events after joint arthroplasty and to provide a specific theoretical basis for clinical treatment. Methods: The review process was conducted according to the PRISMA guidelines. Two independent researchers meticulously screened the literature based on predefined inclusion and exclusion criteria, evaluated the quality of the selected studies, and extracted relevant data. Data analysis was conducted using RevMan 5.4 software. Results: This meta-analysis included 24 studies encompassing a total of 34 811 patients. The pooled analysis showed that the topical administration of VP significantly reduced the incidence of SSI. Subgroup analyses by doses, type of joint (hip and knee), and type of surgery (primary and revision) confirmed that vancomycin consistently lowered SSI rates. Moreover, the incidence of SSI caused by gram-negative germs and gram-positive germs decreased following the use of VP, although the reduction was not significant for infections caused by MRSA. However, the use of VP was associated with a significant increase in sterile complications at the incision site and delayed incision healing. Conclusion: The topical application of VP is effective in reducing the incidence of infections following joint arthroplasty. Despite an increased risk of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision-making. However, it should not be discarded due to side effects.

Intraspecific cooperation allows the survival of Staphylococcus aureus staff: a novel strategy for disease relapse.

BACKGROUND: The contribution of interspecies interactions between coinfecting pathogens to chronic refractory infection by affecting pathogenicity is well established. However, little is known about the impact of intraspecific interactions on infection relapse, despite the cross-talk of different strains within one species is more common in clinical infection. We reported a case of chronic refractory pulmonary infection relapse, caused by two methicillin-sensitive S. aureus (MSSA) strains (SA01 and SA02) and revealed a novel strategy for relapse via intraspecific cooperation. METHODS: The hemolytic ability, growth curve, biofilm formation, virulence genes and response of G. mellonella larvae to S. aureus infection were analysed to confirm this hypothesis. RESULTS: SA02 hemolytic activity was inhibited by SA01, along with the expression of hemolysin genes and the virulence factor Hla. Additionally, SA01 significantly enhanced the biofilm formation of SA02. AIP-RNAIII may be a possible pathway for this interaction. Compared with mono-infection, a worse outcome (decreased larval survival and increased microbial burden) of the two MSSA strains coinfected with G. mellonella confirmed that intraspecific interactions indeed enhanced bacterial survival in vivo. CONCLUSION: The intraspecific interaction of S. aureus could lead to chronic refractory infection via pathogenicity changes.

Laparoscopic anatomical partial splenectomy for extremely rare isolated splenic lymphangioma in an adult: a case report and literature review.

Background: Benign tumors of the spleen are rare compared to those of other parenchymal organs, accounting for less than 0.007% of all tumors, and are often found incidentally. Splenolymphangiomas are much rarer, commonly occur in children, and tend to have multiple foci. Splenic lymphangiomas are rare in adults, and fewer than 20 adult patients with isolated splenic lymphangiomas have been reported. In this article, we report the case of a middle-aged female patient with isolated splenic lymphangioma who underwent laparoscopic anatomical hypophysectomy of the lower pole of the spleen. We also summarize the existing literature on splenic lymphangioma diagnosis and available treatment options. Case presentation: A 58-year-old middle-aged woman was found to have a mass approximately 60 mm in diameter at the lower pole of the spleen during a health checkup that was not accompanied by other symptoms or examination abnormalities. After completing a preoperative examination with no contraindications to surgery, the patient underwent laparoscopic anatomical splenectomy of the lower extremity of the spleen. The patient recovered well without complications and was discharged from the hospital on the 7th postoperative day. Histopathological and immunohistochemical results confirmed the diagnosis of splenic lymphangioma. Prompt surgical intervention is safe and necessary when splenic lymphangiomas are large or associated with a risk of bleeding. Conclusion: Splenic lymphangiomas are rare and require early surgical intervention in patients with large tumor diameters or those at risk of rupture and bleeding. After rigorous preoperative evaluation and preparation, laparoscopic anatomical partial splenectomy is safe and feasible for surgeons with experience in laparoscopic surgery.

The association between accelerated biological aging and the risk of osteoarthritis: a cross-sectional study.

Background: Biological age (BA) offers an effective assessment of true aging state. The progression of Osteoarthritis (OA) is closely associated with an increase in chronological age, the correlation between BA and OA has not been fully elucidated. Methods: This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Thirteen commonly used clinical traits were employed to calculate two measures of BA: the Klemera-Doubal method age (KDM-Age) and phenotypic age (Pheno-Age). The residuals of the regression of these ages based on chronological age were calculated as KDM-Age or Pheno-Age acceleration, respectively. OA was determined through self-reported prior diagnoses. The prevalence of OA across different quartiles of BA was compared using weighted chi-square tests and linear trend tests. The association between BA and OA was assessed using weighted multivariate logistic regression models. Results: A total of 30,547 participants aged ≥20 years were included in this study, 3,922 (14%) were diagnosed with OA. Participants with OA exhibited higher chronological age, KDM-Age, Pheno-Age, KDM-Age advance, and Pheno-Age advance compared to those without OA (p < 0.001). The prevalence of OA significantly increased with higher quartiles of KDM-Age advance and Pheno-Age advance (P for trend < 0.001). In the fully adjusted model, compared to the lowest quartile (Q1) of KDM-Age advance, the highest quartile (Q4) was associated with a 36.3% increased risk of OA (OR = 1.363; 95% CI = 1.213 to 1.532, p < 0.001). The highest quartile of Pheno-Age advance (Q4) was associated with a 24.3% increased risk of OA compared to Q1 (OR = 1.243; 95% CI = 1.113 to 1.389, p < 0.001). In males and young people, no statistical differences were found in OA risk between the highest and the lowest quartiles of KDM-Age advance (p = 0.151) and Pheno-Age advance (p = 0.057), respectively. Conclusion: Adults with accelerated biological aging have an increased risk of OA, particularly among females and older adults.

NLRP3 blockade by MCC950 suppressed osteoclastogenesis via NF-κB/c-FOS/NFATc1 signal pathway and alleviated bone loss in diabetes mellitus.

Obesity and type 2 diabetes mellitus (T2DM) are linked to osteoporosis development, with obesity being a significant risk factor for T2DM. T2DM patients with obesity exhibit a higher fracture rate and often have a poor prognosis post-fracture. To address the urgent need for understanding the mechanisms of diabetic osteoporosis (DOP), research is ongoing to explore how obesity and T2DM impact bone metabolism. The NLRP3 inflammasome has been implicated in the pathogenesis of osteoporosis, and MCC950, an NLRP3 inflammasome inhibitor, has shown promise in various diseases but its role in osteoporosis remains unexplored. In this study, BMMs and BMSCs were isolated and cultured to investigate the effects of MCC950 on bone metabolism, and DOP model was used to evaluate the efficacy of MCC950 in vivo. The study demonstrated that MCC950 treatment inhibited osteoclast differentiation, reduced bone resorption capacity in BMMs without suppression for osteoblast differentiation from BMSCs. Additionally, MCC950 suppressed the activation of the NF-κB signaling pathway and downregulated key factors associated with osteoclast differentiation. Additionally, MCC950 alleviated bone loss in DOP mouse. These findings suggest that MCC950, by targeting the NLRP3 inflammasome, may have a protective role in preventing osteoporosis induced by T2DM with obesity. The study highlights the potential therapeutic implications of MCC950 in managing diabetic osteoporosis and calls for further research to explore its clinical application in high-risk patient populations.

Elucidation of mechanisms underlying active oxygen burst in Citrus sinensis after Diaporthe citri infection using transcriptome analysis.

Introduction: Reactive oxygen species (ROS) generation is a common disease defense mechanism in plants. However, it is unclear whether Citrus host activates defense response against Diaporthe citri causing citrus melanose disease by producing ROS, and the underlying molecular mechanisms are unknown. Methods: DAB staining and RNA-Seq technology were used to compare the active oxygen burst and differential gene expression, respectively, in uninfected and infected Citrus sinensis leaves at different time points during D. citri infection in vivo. The functions of CsRBOH (a significant DEG) were confirmed in N. benthamiana through the Agrobacterium-mediated transient expression system. Results: DAB staining indicated that C. sinensis initiated defense against D. citri infection within 24 h by generating ROS. Illumina sequencing revealed 25,557 expressed genes of C. sinensis. The most upregulated DEGs (n = 1,570) were identified 72 h after fungal inoculation (sample denoted as CD72). In the CD72 vs. Cs (samples at 0 h after fungal inoculation) comparison, the KEGG pathway category with the highest number of genes (n = 62) and most significant enrichment was Protein processing in endoplasmic reticulum, followed by Glutathione metabolism and MAPK signaling pathway-plant. GO analysis revealed that the DEGs of CD72 vs. Cs related to active oxygen burst and chitin recognition were significantly grouped into the regulation of biological processes and molecular functions, with GO terms including response to ROS, response to fungus, and oxidoreductase activity. Remarkably, CsRBOH was significantly enriched in the GO and KEGG analyses, and its expression pattern in qRT-PCR and DAB staining results were consistent. Among the 63 ROS-related DEGs, HSP genes and genes associated with the peroxidase family were highly significant as revealed by protein-protein interaction networks. Furthermore, ROS accumulation, cell death, and upregulation of defense-related genes were observed in N. benthamiana leaves with CsRBOH expressed through the Agrobacterium-mediated transient expression system. Conclusion: Our findings suggested that C. sinensis activates CsRBOH and ROS-related genes, leading to ROS accumulation to resist the invasion by D. citri. This study laid the foundation for future research on molecular mechanisms and breeding of C. sinensis cultivars resistant to citrus melanose.

Predictive Factors for Tissue Inflammation in Patients with Benign Prostatic Hyperplasia: A Clinical Prediction Study.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a common condition in older men, marked by the noncancerous enlargement of the prostate gland. Inflammation of the prostate plays a significant role in the progression of BPH and the symptoms it causes. The objective of this study was to create a predictive model for prostatic inflammation in men with BPH based on important clinical factors. METHODS: A retrospective cohort study was conducted with 137 patients diagnosed with BPH. Data collected included various factors such as age, prostate volume (PV), preoperative international prostate symptom score, preoperative maximum urine flow rate (Qmax), preoperative post-void residue, weight of the excised tissue, body mass index, fasting blood glucose (FBG), cholesterol levels, prostate-specific antigen, blood calcium, blood phosphorus, blood uric acid, triglycerides, hypertension status, and presence of prostate calcifications. Multivariate logistic regression and LASSO regression analyses were performed to identify significant predictors and develop a nomogram. The model's performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA). RESULTS: Among the patients, 9.49% showed no signs of prostatic inflammation, while 22.63% had mild, 47.45% had moderate, and 20.44% had severe inflammation. Factors such as PV, FBG, and prostate calcification were identified as important predictors of prostatic inflammation. The predictive model developed exhibited strong discrimination and calibration, as evidenced by a high area under the curve value, indicating reliable predictive accuracy. DCA further validated the clinical usefulness of the nomogram. CONCLUSION: The developed nomogram, incorporating PV, FBG, and prostate calcification, effectively predicts prostatic inflammation in men with BPH. This tool can aid in early intervention and targeted treatment, potentially improving patient outcomes. Further validation in diverse populations is recommended to enhance its generalizability and clinical applicability.

Association between arteriosclerosis index and lumbar bone mineral density in U.S adults: a cross-sectional study from the NHANES 2011-2018.

Background: The arteriosclerosis index, defined as the ratio of non-high density lipoprotein cholesterol to high density lipoprotein cholesterol (NHHR), has emerged as a novel biomarker for various diseases. The relationship between NHHR and lumbar bone mineral density (BMD) has not been previously examined. Methods: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. NHHR was calculated as (total cholesterol-high-density lipoprotein cholesterol)/high-density lipoprotein cholesterol. Lumbar BMD was calculated to Z scores. Weighted multivariate linear regression, subgroup analysis, interaction analysis, generalized additive model, and two-piecewise linear regression were used. Results: A total of 8,602 participants were included. The negative association between NHHR and lumbar BMD was consistent and significant (Model 1: ß = -0.039, 95% CI: -0.055, -0.023, p < 0.001; Model 2: ß = -0.045, 95% CI: -0.062, -0.027, p < 0.001; Model 3: ß = -0.042, 95% CI: -0.061, -0.023, p < 0.001). The linear relationship between NHHR and lumbar BMD was significantly influenced by body mass index (p for interaction = 0.012) and hypertension (p for interaction = 0.047). Non-linear associations between NHHR and lumbar BMD Z scores were observed in specific populations, including U-shaped, reverse U-shaped, L-shaped, reverse L-shaped, and U-shaped relationships among menopausal females, underweight participants, those with impaired glucose tolerance, those with diabetes mellitus and those taking anti-hyperlipidemic drugs, respectively. Conclusions: NHHR exhibited a negative association with lumbar BMD, but varying across specific populations. These findings suggest that NHHR should be tailored to individual levels to mitigate bone loss through a personalized approach. Individuals at heightened risk of cardiovascular disease should focus on their bone health.

The function of the inter-alpha-trypsin inhibitors in the development of disease.

Through the formation of covalent connections with hyaluronic acid (HA), the inter-α-trypsin inhibitor (IαI) family collaborates to preserve the stability of the extracellular matrix (ECM). The five distinct homologous heavy chains (ITIH) and one type of light chain make up the IαI family. ITIH alone or in combination with bikunin (BK) has been proven to have important impacts in a number of earlier investigations. This implies that BK and ITIH might be crucial to both physiological and pathological processes. The functions of BK and ITIH in various pathophysiological processes are discussed independently in this paper. In the meanwhile, this study offers suggestions for further research on the roles of BK and ITIH in the course of disease and summarizes the plausible mechanisms of the previous studies.

Efficacy and safety of topical tranexamic acid in spinal surgery: a systematic review and meta-analysis.

Purpose: This study aimed to assess the effects of topical tranexamic acid (tTXA) in spinal surgery to provide reliable clinical evidence for its usefulness. Methods: The PubMed, EMBASE, Medline, and Cochrane Central Register of Controlled Trials databases were comprehensively searched to identify randomized controlled trials and non-randomized controlled trials evaluating the effect of tTXA on blood loss during spine surgery. The observation indexes were intraoperative blood loss, total blood loss, output and duration of postoperative drainage, postoperative hematological variables, length of postoperative hospital stay, blood transfusion rate, and complication rate. Results: A total of 21 studies involving 1774 patients were included. Our results showed that the use of tTXA during spinal surgery significantly reduced the total blood loss, postoperative drainage volume, postoperative transfusion rate, duration of postoperative drainage, and postoperative hospital stay, and increased the serum hemoglobin concentration, thereby providing better clinical outcomes for surgical patients. However, tTXA had no effect on intraoperative blood loss and associated complications. Conclusion: On the basis of the available evidence, the present results provide strong clinical evidence of the clinical value of tTXA in spinal surgery and provide an important reference for future research and clinical decision-making.

Safety and efficacy of aspirin and indobufen in the treatment of coronary heart disease: a systematic review and meta-analysis.

Purpose: This meta-analysis aimed to compare the safety and efficacy of aspirin and indobufen in patients with coronary heart disease. The primary focus was on the incidence of cardiovascular events, bleeding events, and gastrointestinal reactions. Given the relatively limited research on indobufen, this study utilized aspirin as a control drug and employed meta-analysis to integrate existing clinical studies. The goal was to provide a reference for the clinical use of indobufen and to suggest directions for further largescale, multicenter prospective studies. Methods: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a comprehensive search of the PubMed, EMBASE, WOS, and Cochrane Library databases to identify all relevant literature on indobufen. A total of nine trials met the inclusion criteria, encompassing seven randomized controlled trails (RCTs) and two retrospective studies. Categorical variables were analyzed using odds ratio and random effects models. Results: The meta-analysis included nine trials, comprising seven RCTs and two retrospective studies. The pooled results indicated that indobufen significantly reduced the incidence of minor bleeding events, and gastrointestinal discomfort compared to aspirin. However, both drugs had similar effects on the incidence of recurrent angina pectoris, myocardial infarction and mortality due to coronary heart disease. Conclusion: Indobufen was associated with fewer gastrointestinal reactions and a low risk of bleeding, making it a viable option for patients with high-risk factors for bleeding and gastric ulcers. Despite this, indobufen's short history and limited evidence base compared to aspirin highlight the need for further research. Aspirin remains widely available, cost-effective, and the preferred drug for the primary and secondary prevention of cardiovascular and cerebrovascular diseases. Indobufen or other antiplatelet agents should only be considered when aspirin is not tolerated or contraindicated. Further clinical trials are necessary to determine whether indobufen can replace aspirin. Systematic Review Registration: https://www.crd.york.ac.uk/, identifier [CRD42024523477].

Pharmacological activity and clinical application analysis of traditional Chinese medicine ginger from the perspective of one source and multiple substances.

All types of ginger have common fundamental components, although they possess distinct strengths and inclinations when it comes to effectiveness and medicinal applications. Fresh ginger possesses the ability to effectively stimulate movement within the body, alleviate the act of vomiting, induce sweating, and provide relief for external syndromes. Dried ginger possesses both defensive and stimulant characteristics, which effectively raise the internal temperature and enhance the Yang energy. Fresh ginger is more hydrating than dried ginger, highly skilled at heating the Middle-jiao, alleviating pain, halting bleeding, and managing diarrhea. Dried ginger possesses the ability to alleviate coldness when consumed in a heated form, as well as to alleviate diarrhea when consumed in a heated form. It thrives in warm conditions and has a tendency to revert back to its warm nature. The moisture content of baked ginger is inferior to that of dried ginger, but it is highly effective in alleviating pain, bleeding, and diarrhea by warming the Middle-jiao. Ginger charcoal and stir-fried charcoal, produced through carbonization, have excellent heat retention properties and are effective in warming meridians and stopping bleeding. The potency and ability to spread of roasted ginger is less intense compared to fresh ginger, and its moisture content is not as low as that of dried ginger. The medicinal characteristics of this substance are gentle, making it beneficial for alleviating vomiting in patients who are physically frail. Its primary mode of action is on the Middle-jiao. Nevertheless, the main chemical compositions of various traditional Chinese medicines are nearly identical due to their shared base element. Ginger, in particular, possesses a range of pharmacological activities including antioxidant, anti-inflammatory, anti-tumor, anti-bacterial, and anticoagulant properties. However, modern pharmacological research has not fully acknowledged the clinical medicinal value of ginger and consequently, fails to provide accurate guidance for clinical medication. This situation has a negative impact on the contemporary advancement of traditional Chinese medicine (TCM). The research on modernizing ginger is conducted by analyzing and considering the prospects. It is based on Traditional Chinese Medicine (TCM) theory and incorporates the comprehensive perspective of TCM philosophy. In order to modernize ginger, it is essential to have a proper knowledge of the concepts of "recognizing nature by efficacy, homology, and mutual expression of nature and efficacy" and "rationally utilizing modern drug research technology". By applying these principles, we can construct a bridge towards the advancement of ginger.

Brain functional gradient and structure features in adolescent and adult autism spectrum disorders.

Understanding how function and structure are organized and their coupling with clinical traits in individuals with autism spectrum disorder (ASD) is a primary goal in network neuroscience research for ASD. Atypical brain functional networks and structures in individuals with ASD have been reported, but whether these associations show heterogeneous hierarchy modeling in adolescents and adults with ASD remains to be clarified. In this study, 176 adolescent and 74 adult participants with ASD without medication or comorbidities and sex, age matched healthy controls (HCs) from 19 research groups from the openly shared Autism Brain Imaging Data Exchange II database were included. To investigate the relationship between the functional gradient, structural changes, and clinical symptoms of brain networks in adolescents and adults with ASD, functional gradient and voxel-based morphometry (VBM) analyses based on 1000 parcels defined by Schaefer mapped to Yeo's seven-network atlas were performed. Pearson's correlation was calculated between the gradient scores, gray volume and density, and clinical traits. The subsystem-level analysis showed that the second gradient scores of the default mode networks and frontoparietal network in patients with ASD were relatively compressed compared to adolescent HCs. Adult patients with ASD showed an overall compression gradient of 1 in the ventral attention networks. In addition, the gray density and volumes of the subnetworks showed no significant differences between the ASD and HC groups at the adolescent stage. However, adults with ASD showed decreased gray density in the limbic network. Moreover, numerous functional gradient parameters, but not VBM parameters, in adolescents with ASD were considerably correlated with clinical traits in contrast to those in adults with ASD. Our findings proved that the atypical changes in adolescent ASD mainly involve the brain functional network, while in adult ASD, the changes are more related to brain structure, including gray density and volume. These changes in functional gradients or structures are markedly correlated with clinical traits in patients with ASD. Our study provides a novel understanding of the pathophysiology of the structure-function hierarchy in ASD.

Treatment of lower cervical spine fracture with ankylosing spondylitis by simple long anterior cervical plate: a retrospective study of 17 cases.

Objective: Ankylosing spondylitis (AS), an autoimmune disease, often leads to lower cervical spine fractures, with the potential for severe spinal nerve damage even from low-energy injuries. The optimal treatment approach remains debated. Methods: A retrospective study involved 17 AS patients with lower cervical spine fractures who received anterior cervical fixation. Most presented cervicothoracic or thoracolumbar kyphosis, with 11 exhibiting neurological deficits. Patient characteristics, clinical data, visual analog scale (VAS), complications, and nerve recovery were analyzed. Results: No postoperative neurological deterioration occurred. All cases experienced complete fusion of fractures during the follow-up period. Preoperative VAS significantly decreased at 3 days and 3 months post-surgery. Of the 11 patients with preoperative neurological deficits, approximately 54.5% showed improvement post-surgery. No complications were reported, such as esophageal fistula, wound infection, or fixation failure. Conclusion: Anterior internal fixation is a possible treatment for AS-related lower cervical fractures. This approach ensures satisfactory spinal stability and neurological recovery with proper cranial traction and external fixation post-surgery. Our findings demonstrate that this surgical method is safe and effective.

Case report and literature review: Laparoscopic extended right hemicolectomy for a 55-year-old patient with idiopathic mesenteric phlebosclerosis.

Idiopathic mesenteric phlebosclerosis (IMP) is an extremely rare disease with an unclear pathogenesis and risk factors. The clinical manifestations of IMP are mostly non-specific, mainly consisting of digestive symptoms such as abdominal pain, bloating and diarrhea. The diagnosis of IMP mainly relies on abdominal computed tomography (CT) and colonoscopy. Pathological changes associated with IMP often involve fibrous degeneration of the venous wall, which results in the thickening of the colonic wall and longitudinal calcification of the mesenteric arteries. Currently, there is no standard treatment protocol for IMP, and nonsurgical treatment is the mainstay of most medical centers. In this study, we reported a case of a 55-year-old female patient with IMP whose main clinical presentation was recurrent abdominal pain. The patient's initial diagnosis was considered an incomplete intestinal obstruction and received non-surgical treatments; however, the efficacy of the treatment was unsatisfactory. After completing abdominal CT and colonoscopy, we excluded common diseases of the digestive system (e.g., tumors, Crohn's disease), and finally considered that this patient had a high likelihood of IMP. This patient eventually underwent laparoscopic enlarged right hemicolectomy due to recurrent symptoms and poor outcomes of non-surgical treatment. Postoperative pathological results confirmed the diagnosis of IMP. During the follow-up period, the patient recovered well without recurrence of IMP. Furthermore, we have reviewed the literature related to IMP and summarized the etiology, risk factors, diagnostic methods, treatment options and prognosis of IMP.